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At least 91 records · Page 5Linked to original sources

PubMed1997

Nativity, race, and mortality: favorable impact of birth outside the United States on mortality in New York City.

To determine the association of birthplace (US-born vs. foreign-born) with mortality among blacks and whites in New York City, we examined death records for 5 years from 1988 to 1992 and the 1990 census data. Mortality rates by race and birthplace were compared for all causes of death and for specific causes. Although overall death rates for blacks generally exceeded those for whites (1224.8 per 100,000 inhabitants vs. 721.4 for males and 593.7 vs. 393.1 for females), foreign-born blacks had death rates (664.6 for males and 350.2 for females) slightly lower than those for whites. The most striking variation among blacks was among those aged 25 to 64 years. US-born black males were three times as likely (1588.9 vs. 525.2) and US-born black females were more than 2.5 times as likely (673.5 vs. 263.4) to die as were foreign-born blacks. Among US-born blacks AIDS, homicide, and cancer for males and AIDS, heart disease, and cancer for females were the most important determinants of excess deaths, defined as the difference between observed deaths and expected deaths; these causes of death account for about half of the excess deaths for each sex. Among whites natives generally had higher death rates than migrants, but less prominently and consistently so than for blacks. Excess mortality of blacks is largely explained by higher death rates of US-born compared with foreign-born Americans.

Adolescent↗

PubMed1989

Determination of death by neurological criteria.

Since 1981, Missouri law has defined death as occurring when cardiopulmonary function has ceased or when all brain and brain stem function is totally and irreversibly lost. The author reviews the current published guidelines for the determination of death by neurological criteria in order to assist physicians making the evaluation.

Brain↗

PubMed1999

Drug-related mortality in Denmark 1970-93.

We analysed drug-related mortality in Denmark with respect to secular trends, gender, and regional variations, for the period 1970-93, for all deaths from poisoning and among drug addicts. The study was based on the Register of Causes of Death in Denmark and included 6,229 drug-related deaths, defined by specific combinations of manner of death, underlying cause of death, and contributory cause of death. The main outcome measure is age-specific mortality rate. A total of 63% of the drug-related deaths were registered as unnatural deaths. During the period studied, mortality increased for men in the 25 49 year age group and for women in all age groups over 25 years of age. For both men and women, the youngest birth cohorts from the mid-1950s and 1960s suffered much higher mortality than those born before 1950; however, the three youngest birth cohorts had almost the same mortality. During the entire period, mortality in the capital, Copenhagen, was much higher than in the provinces, but in the last years, a more favourable trend has been seen in Copenhagen.

Adolescent↗

PubMed2005

Ethnic differences in neonatal and postneonatal mortality.

OBJECTIVE: Ethnic disparities in infant mortality have been consistently documented in the United States, but these disparities are poorly understood. Although the infant mortality rate in the United States has fallen to record low rates, since 1971 the ethnic disparity between black and white infants has remained unchanged or increased. In 2001, the infant mortality rate among black infants was approximately 2.5 times higher than the rate among white and Hispanic infants. The objective of this study was to identify ethnic differences in neonatal and postneonatal mortality as well as the causes and risk factors among infants born in California. METHODS: Secondary analysis was performed of 1,277,393 singleton infants live-born to black, Latina, and white women from the California linked birth-infant death certificate from 1995 to 1997. The dependent variables were infant death (defined as an infant who died in the first year of life [death <365 days]), neonatal death (death during the first 27 days of life), and postneonatal death (death between 28 and 364 days of life). Cause-specific neonatal and postneonatal infant mortality rates (per 100,000 live births) were calculated for each ethnic group. Chi(2) and exact test statistics were used to compare the distribution of maternal and infant characteristics and cause-of-death rates by maternal ethnicity. Logistic regression analysis was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) to estimate the relationship between maternal ethnicity, maternal and infant factors, and risk of infant mortality. RESULTS: In both the neonatal and postneonatal periods, black women had higher infant mortality rates than Latina or white women for conditions originating in the perinatal period (including respiratory distress syndrome) and symptoms, signs, and ill-defined conditions (including sudden infant death syndrome). After adjusting for maternal and infant characteristics, there were no significant ethnic differences for neonatal mortality. For postneonatal mortality, black women had a higher risk (OR: 1.25; 95% CI: 1.10-1.42) and Latina women had a lower risk (OR: 0.80; 95% CI: 0.71-0.89) compared with white women after adjusting for maternal and infant factors. In analyses of all ethnic groups combined, as well as ethnic-specific analyses, the strongest predictors of neonatal and postneonatal death were infant birth weight of <2499 g and gestational age of <33 weeks. CONCLUSIONS: Causes of infant mortality and risk factors for infant mortality differed by maternal ethnicity, indicating a need to tailor prevention and education efforts, especially during the postneonatal period. To achieve national infant mortality goals, health professionals and policy makers should continue to emphasize the importance of early and continuous prenatal care and develop new strategies to reduce the incidence of low birth weight and premature infants. Ethnic-specific approaches may be needed to further reduce infant mortality rates and achieve our national goal to eliminate ethnic disparities in perinatal outcomes.

Adolescent↗

PubMed2002

Possible underascertainment of variant Creutzfeldt-Jakob disease: a systematic study.

OBJECTIVES: To predict the size of the vCJD epidemic it is important to know whether the description of cases of vCJD in 1996 represent the first cases of a new disease entity or whether detection was due to increased surveillance of CJD in humans. Detection of earlier cases would suggest a shorter incubation period and might lead to predictions of epidemic size being revised. METHODS: All certified deaths (excluding external injury and poisoning) in residents of Wales aged 15-45, between 1985 and 1995, were reviewed to detect vCJD deaths that might have been overlooked. 12 091 deaths were reviewed. "Non-specific fatal disorders compatible with vCJD" were defined. Deaths recorded to diseases other than those defined were rejected from further analysis (8769). Remaining cases (3322) were subdivided. Group A comprised deaths recorded to suicide, transport accidents, and those that could not be ascertained (ICD9 rubrics E950-959, E800-848, and 7999), a total of 2698 cases. Group B comprised deaths due to neurological disease, psychiatric disease, or substance abuse (624). RESULTS: For group A, remaining brain material was identified (n=218, 8.1%) and examined by routine histology and immunocytochemistry for prion protein. No cases of vCJD were detected. For group B, review of remaining clinical information was undertaken. Of 624 cases, information was available on 447 (72%). Brain tissue was examined by routine histology and immunocytochemistry in 47 (7.5%) cases. Sufficient clinical and pathological information was available to exclude all these as potential cases of vCJD. CONCLUSION: Variant CJD is a new disease entity and not simply the result of better case ascertainment.

Adolescent↗

PubMed2000

Low protein diets delay end-stage renal disease in non diabetic adults with chronic renal failure.

BACKGROUND: Since more than fifty years, low protein diets are proposed to patients with kidney failure. However, the effects of these diets in preventing severe renal failure and the need for maintenance dialysis is still controversial. OBJECTIVES: To determine the efficacy of low protein diets in delaying the need to start maintenance dialysis. SEARCH STRATEGY: Medline and Embase search from January 1966 through June 1999. Congress abstracts (American Society of Nephrology since 1990, European Dialysis Transplant Association since1985, International Society of Nephrology since 1987). Direct contacts with investigators. SELECTION CRITERIA: Randomised trials comparing two different levels of protein intake in adult patients suffering from moderate to severe renal failure, followed for at least one year. Exclusion of patients with diabetic nephropathy. DATA COLLECTION AND ANALYSIS: Seven trials selected over 40 studies since 1975. A total of 1494 patients analysed, 753 receiving a reduced protein intake and 741 a larger protein intake. Collection of the number of "renal death" being the need for starting dialysis, the death of a patient or the transplantation of a kidney during the trials. MAIN RESULTS: 242 renal deaths were recorded, 101 in the low protein diet and 141 in the larger protein diet group, giving an odds ratio of low protein to control of 0.62 with a 95% confidence interval of 0.46 to 0.83 (p<0.001, Peto odds ratio). To spare one extra renal death, 17 patients need to be treated (NNT) with a low protein diet for approximately two years. REVIEWER'S CONCLUSIONS: Reducing protein intake in patients with chronic renal failure do reduce the occurence of renal death by about 40% as compared with larger or unrestricted protein intake and therefore should be warmly recommended to patients. The optimal level of protein intake cannot be deduced from the present work. However, based on other nutritional studies perfomed in patients having chronic renal failure, we recommend a protein intake of 0.6 g/kg/day and an energy intake no less than 35 kcal/kg/day. Skilled dietitian survey should be offered to closely monitor these values and the patient's nutritional status.

Adult↗

PubMed2006

Low protein diets for chronic kidney disease in non diabetic adults.

BACKGROUND: For more than fifty years, low protein diets have been proposed to patients with kidney failure. However, the effects of these diets in preventing severe renal failure and the need for maintenance dialysis have not been resolved. OBJECTIVES: To determine the efficacy of low protein diets in delaying the need to start maintenance dialysis. SEARCH STRATEGY: Cochrane Renal Group trials register, the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Congress abstracts (American Society of Nephrology since 1990, European Dialysis Transplant Association since 1985, International Society of Nephrology since 1987). Direct contacts with investigators. Date of most recent search: December 2004. SELECTION CRITERIA: Randomised trials comparing two different levels of protein intake in adult patients suffering from moderate to severe renal failure, followed for at least one year. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected studies and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes with 95% confidence intervals (CI). Collection of the number of "renal deaths" defined as the need for starting dialysis, the death of a patient or a kidney transplant during the trial. MAIN RESULTS: Eight trials were identified from over 40 studies. A total of 1524 patients were analysed, 763 had received reduced protein intake and 761 a higher protein intake. Two hundred and fifty one renal deaths were recorded, 103 in the low protein diet and 148 in the higher protein diet group (RR 0.69, 95% CI 0.56 to 0.86, P = 0.0007). To avoid one renal death, 2 to 56 patients need to be treated with a low protein diet during one year. AUTHORS' CONCLUSIONS: Reducing protein intake in patients with chronic kidney disease reduces the occurrence of renal death by 31% as compared with higher or unrestricted protein intake. The optimal level of protein intake cannot be confirmed from these studies.

Adult↗

PubMed2000

Low protein diets delay end-stage renal disease in non-diabetic adults with chronic renal failure.

BACKGROUND: The objective of this study was to determine the efficacy of low protein diets in delaying the need to start maintenance dialysis based on an analysis of published literature. METHODS: The search strategy involved a Medline and Embase search from January 1966 through to June 1999, congress abstracts (American Society of Nephrology since 1990, European Dialysis Transplant Association since 1985, International Society of Nephrology since 1987) and direct contacts with investigators. The selection criteria included randomized trials comparing two different levels of protein intake in adult patients suffering from moderate to severe renal failure, followed for at least 1 year. Patients with diabetic nephropathy were excluded. Seven trials were selected from 40 studies since 1975. A total of 1494 patients were analysed: 753 had received reduced protein intake and 741 a higher protein intake. The numbers of 'renal deaths' (defined as the need for starting dialysis, the death of a patient or kidney transplant during the trial) were collected. RESULTS: 242 renal deaths were recorded, 101 in the low protein diet and 141 in the higher protein diet group, giving an odds ratio of 0.61 with a 95% confidence interval of 0.46 to 0.83 (P=0.006). CONCLUSION: Reducing protein intake in patients with chronic renal failure reduces the occurrence of renal death by about 40% as compared with larger or unrestricted protein intake. The optimal level of protein intake cannot be confirmed from these studies.

Chronic Disease↗

PubMed1994

Suicide in the mentally ill. An epidemiological sample and implications for clinicians.

BACKGROUND: Information on risk factors associated with high rates of suicide is necessary, if suicide rates among the mentally ill are to be reduced. METHOD: We used ICD-9 E-codes to define deaths on which suicide or open (undetermined death) verdicts were returned, among residents of a catchment area defined by OPCS area codes. Relative risks of suicide and undetermined deaths for recent patients (those in contact with a psychiatric service in the year preceding death) were calculated. RESULTS: Of the 286 persons, 108 were recent patients. Eighty-four per cent suffered from schizophrenia or depression. Risks of suicide and undetermined death for these patients were 31 and 20 times, respectively, those of other residents. Social risk factors varied with diagnosis. CONCLUSION: Over 90% of recent patients were receiving medical care at time of death; not all were treated appropriately. Recognising medical and social risk factors in recent patients, and effective monitoring of treatment, is important.

Adolescent↗

PubMed2000

LET dependency of heavy-ion induced apoptosis in V79 cells.

We investigated the relationship between the LET values and cell death, defined as either apoptosis or loss of reproductive integrity (reproductive death), using Chinese hamster V79 cells. The cells were irradiated with X-rays or carbon-ion beams from the Heavy Ion Medical Accelerator in Chiba (HIMAC) at the National Institute of Radiological Sciences (NIRS). Apoptosis was defined based on the morphological change upon treating of cells with caffeine. The apoptotic index, the ratio of apoptotic cells to the total, after exposure to 2 Gy of X-rays was 0.043. Upon irradiation with carbon-ion beams, the index was gradually increased with increasing LET values, reaching a maximum of 0.076 at 110 keV/micron, and then decreased to 0.054 at 237 keV/micron. An analogous pattern of the LET dependence was observed between reproductive death and apoptotic death. The cell-survival values obtained after 2 Gy exposure (SF2) were 0.64, 0.13, and 0.24, respectively. A similar trend was found for the RBE values calculated from the initial slope for both apoptosis and reproductive death. These results strongly suggest that the target for both types of cell death is the same.

Animals↗

PubMed2003

Identifying under-performing surgeons.

OBJECTIVE: To estimate the likelihood of poor surgical results being explained by chance rather than under-performance. METHODS: The 30-day mortality rates after radical cystectomy for bladder cancer were analysed theoretically. Surgical competence was defined as a mortality rate of 4%, excellence as 2% and under-performance as 8%, 12%, 20% or 40%. Four scenarios were explored for surgeons of different competence: first, the sample size required to show that a given level of under-performance is very unlikely to be due to chance; second, the likelihood of two or more consecutive deaths in a series of cases; third, the likelihood of clustering of deaths, defined as two deaths in five or in 10 cases; and last, the likelihood of outstanding surgical results (i.e. no deaths) being achieved in small cohorts by surgeons of differing competence. RESULTS: For surgeons with a mortality rate of 8%, 12%, 20% or 40%, the sample sizes needed to prove under-performance are 211, 65, 21 and seven, respectively. For consecutive deaths, 0.4% of excellent, 1.4% of competent and 21% of surgeons with a mortality rate of 12% will experience two or more consecutive deaths in the next 10 cases. For clustered deaths, 1% of excellent, 5% of competent and 23% of seriously under-performing surgeons (mortality rates > or = 12%) will experience two deaths in their next 10 cases. Lastly, for the likelihood of outstanding results, only 3.6% of surgeons with an 8% mortality rate and < 1% of surgeons with a mortality rate > or = 12% will experience no deaths over 40 consecutive cases. CONCLUSIONS: Very large cohorts are needed to confirm even significant under-performance. Consecutive deaths are very unlikely events for competent surgeons. Clustered deaths (two deaths in 10 cases) are very unlikely events for excellent surgeons but plausible for competent ones. Analysis of consecutive/clustered deaths is limited by low statistical sensitivity; only up to a quarter of seriously under-performing surgeons are identified. No deaths in 40 consecutive cases implies competence.

Clinical Competence↗

PubMedDate not supplied

[Drug deaths].

In the Federal Republic of Germany there exist no statistical datas concerning death related to drug dependence until now. We propose to define death in connexion with drug dependence as the death of a drug dependent person caused by direct or indirect effect of the drug used. We first report on several international investigations; then the results of our own investigation in 40 cases of death in connexion with drug dependence in the district of Nordbaden are presented in detail. As a result it seems necessary to register drug dependent persons and to isolate those who are resistent to any therapy and thus represent a focus for further expansion of drug consuming.

Accidents↗

PubMed2002

"Face-to-face with It": medical students' narratives about their end-of-life education.

Medical schools have been slow to include meaningful end-of-life (EOL) educational experiences in their curricula. As an area of inquiry and focused clinical experience, death is "conspicuous" by its absence, reflecting a medical culture that defines death as failure. The author asked fourth-year medical students at one institution to describe their experiences with dying patients and their families, the skills and attitudes they brought to these encounters, the support they received from attendings and residents while caring for dying patients, and suggestions for the medical curriculum that would help prepare them for care of the dying. Using a qualitative method, she analyzed ten students' written narratives, which dealt with experiences during their third-year clerkships, and compared these reflections with the literature on EOL care in medical education. The themes that emerged provided four organizers for this essay: (1) students' worry and uncertainty about EOL care, (2) guidance and role modeling in EOL care, (3) preparation for EOL care, and (4) conclusions and recommendations for the medical curriculum. In general, students did not feel well prepared or supported as they cared for their first dying patients, including, for example, delivering a terminal prognosis or obtaining a DNR. However, while they did wish for more support and role modeling from residents and attendings, they generally believed that care of the dying can be learned only through direct clinical experience. These beliefs call into question curricular issues of placement of EOL inquiry--most often in the preclinical curriculum--and the teaching of its content, currently overwhelmingly by lectures. The author concludes with recommendations for thoughtful, integrative, interdisciplinary curriculum changes in EOL education.

Anecdotes as Topic↗

PubMed1990

Sentinel Health Events (Occupational): analysis of death certificates among residents of Nassau County, NY between 1980-82 for occupationally related causes of death.

Death certificates for residents of Nassau County, New York dying between 1980 and 1982 were examined for causes of death defined as Sentinel Health Events (Occupational) (SHE(O]. Of 16,193 deaths from all causes, 2,286 (14.1 percent) were identified as SHE(O) deaths; 142 (6.2 percent) of these were matched for occupational and/or industry, 13 (9.2 percent) of which required no further match [corrected] because the cause of death was inherently related to the occupation or industry. Malignant neoplasms of the trachea, bronchus, or lung were the most frequently occurring SHE(O), accounting for 60 percent of all SHE(O) deaths and 81 percent of matched SHE(O) deaths. The construction industry was associated with the vast majority of such deaths.

Adolescent↗

PubMedDate not supplied

The compression of morbidity debate in aging: an empirical test using the gerontological and geriatric population studies in Göteborg, Sweden (H70).

The H70 longitudinal study of aging, Göteborg, Sweden is used to empirically test the compression of morbidity theory advanced by. We reconceptualize compression as postponement of morbidity in the sense of decreasing amounts of illness for increasingly long life spans. Operationally, morbidity is defined as the average number of hospital days in the last year of life. The date of death and the date of 1-year prior to death define the risk period. The linear regression model with age at death, age at death squared, year of birth, and sex are statistically significant with the oldest having the fewest hospital days. The findings offer partial support for the compression of morbidity theory.

Aged↗

PubMed1977

Progress in legal definition of brain death and consent to remove cadaver organs.

The availability of cadaver kidneys for transplantation falls far short of the needs of a rapidly expanding population of patients on chronic hemodialysis. Kidneys with the least ischemic injury come from donors with fatal head injury or stroke; such kidneys can be removed from a "beating-heart" cadaver after declaring death on the basis of brain death. To clarify the legal status of brain death and to encourage salvage of transplantable kidneys with minimal ischemic injury, 12 states already have codified the concept of brain death. Although the first few laws were lengthy and included medical terms, six of the last seven laws have used one or two models proposed by the American Bar Association (ABA) and the Institute of Society, Ethics and Life Sciences, Hastings-on-Hudson, N. Y. The ABA proposal is the simpler of the two models and should provide the basis for future state laws. In addition, the National Conference of Commissioners on Uniform State Laws plans to present a model law to define death and the liabilities of a physician who declares death on the basis of brain death by mid 1977. While state legislatures have written laws that establish the legality of the concept of brain death, medical groups have sought to define the medical criteria for its determination. The most recent list of criteria comes from a National Institutes of Health-supported Collaborative Study on Cerebral Survival, as follows: (1) unresponsivity, (2) apnea, (3) dilated pupils and absent cephalic reflexes, (4) electrocerebral silence, (5) a confirmatory test of absent cerebral blood flow (angiography, isotope bolus curve, retinoscopy, or echoencephalography).

Brain Death↗

PubMed2006

The impact on relative risk estimates of inconsistencies between ICD-9 and ICD-10.

BACKGROUND: The 10th revision of the International Classification of Diseases (ICD) represents a major change in the ICD system. This paper investigates the impact on relative risk estimates of inconsistencies in outcome classification between ICD-9 and ICD-10, including scenarios in which occupational exposure levels are correlated with year of death (and therefore with the ICD revision in effect at death). The setting of interest is a cohort mortality study in which follow up spans the periods during which ICD-9 and ICD-10 were in effect. The relative risk estimate obtained when death certificates are coded to the ICD revision in effect at time of death is compared to the relative risk estimate that would be obtained if all death certificates were coded to a consistent ICD revision (that is, ICD-10). The ratio of these relative risks is referred to as the coefficient of bias. METHODS: Simple equations relate the coefficient of bias to the sensitivity and specificity of the classification of decedents into categories of cause of death via ICD-9 (treating classifications based upon ICD-10 as the standard). Bridge coded mortality data for 2,296,922 decedents (that is, death certificates coded to ICD-9 and ICD-10) are used to derive estimates of sensitivity and specificity by category of cause of death. Numerical examples illustrate the application of these equations. RESULTS: Estimates of the sensitivity of classification of decedents into categories of death defined by ICD-9 ranged from 0.26-1.00. Specificity was above 0.98 for all categories of cause of death. Numerical examples illustrate that inconsistencies in outcome classification between ICD-9 and ICD-10 may have substantial impact on relative risk estimates if there is a strong relation between exposure status and the proportion of deaths coded to a given ICD revision. CONCLUSIONS: For analyses of mortality outcomes that exhibit poor comparability between ICD-9 and -10, it may be prudent to recode cause of death information to a standard ICD revision in order to avoid bias that can occur when exposures are correlated with the proportion of deaths coded to a given ICD revision.

Cause of Death↗

PubMed1999

Sudden Cardiac Death.

Great strides have been made in the approach to the management of sudden cardiac death. Patients who have been successfully resuscitated from an episode of sudden cardiac death are at high risk of recurrence. Much larger groups of patients who have not had episodes of sudden cardiac death are also at substantial risk for this event, however. Because the survival rates associated with out-of-hospital cardiac arrest are dismal, these high-risk populations must be targeted for prophylaxis. Beta-blockers have been shown to be an effective pharmacologic therapy in patients who have had myocardial infarction and, most recently, in patients with congestive heart failure. When possible, these agents should be used in these populations. No class I or class III antiarrhythmic drugs, with the possible exception of amiodarone, have been shown to have efficacy as prophylactic agents for the reduction of mortality in these populations. In patients who have hemodynamically significant sustained ventricular tachyarrhythmias or an aborted episode of sudden cardiac death, the current therapy of choice is an implantable cardioverter-defibrillator (ICD). For prophylaxis of sudden cardiac death in patients who have not had a previous event, several approaches may be considered. Currently, the best therapeutic approach for prophylaxis of sudden cardiac death seems to be the ICD; however, use of this device can be justified only in patients at substantial risk of sudden cardiac death. Defining the high-risk populations that will benefit from ICDs is critical in managing the problem of sudden cardiac death.

Journal Article↗